Provider Demographics
NPI:1699390492
Name:JENNINGS, LATONIA A (LCSW, MA, EDS)
Entity Type:Individual
Prefix:MS
First Name:LATONIA
Middle Name:A
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:LCSW, MA, EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2724 BROOKHAVEN VW NE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30319-5402
Mailing Address - Country:US
Mailing Address - Phone:850-346-8439
Mailing Address - Fax:
Practice Address - Street 1:2724 BROOKHAVEN VW NE
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30319-5402
Practice Address - Country:US
Practice Address - Phone:850-346-8439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-08
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW145771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical